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Goiter/normal thyroid function/hypothyroid symptoms
Hey everyone!
Is it possible to still have hypothyroid while having normal TSH, Free T4 and Total T3 levels? A little history: about a year and a half ago I was getting reoccurring sinus infections. Lots of pressure and pain in my face/head/neck. I went to an ENT and they found a goiter/enlarged thyroid. Did a scan and determined it was okay. I followed up with an endocrinologist and he stated "You have a big thyroid, ya know, like how some people have big noses. You have a big thyroid." Ummm, what? How does that make any sense? I never had an enlarged thyroid, and now all of a sudden I do...obviously there is an issue there. But I digress...so all of this occurred a year and a half ago. During this year and a half I have been getting migraines, anxiety attacks, depressed, no energy at all (I go to bed at 10:30pm and wake at 7:00am), brain fog, feeling 'out of it', always run down, irritable, constipated etc. I can be here all day naming my symptoms. I went to multiple doctors and had multiple tests done. All coming back 'normal. Now, over the past few months my symptoms have been getting worse and now I am having difficulty breathing/swallowing. So, my question is....is it possible to have hypothyroidism with normal lab results? Any one else experience this? It is impossible to get an appointment with an endocrinologist where I live, my appointment is April 9th and this is the earliest they had! All other doctors were booking appointments in May :-(
Thank you for reading!
-Marisa
Is it possible to still have hypothyroid while having normal TSH, Free T4 and Total T3 levels? A little history: about a year and a half ago I was getting reoccurring sinus infections. Lots of pressure and pain in my face/head/neck. I went to an ENT and they found a goiter/enlarged thyroid. Did a scan and determined it was okay. I followed up with an endocrinologist and he stated "You have a big thyroid, ya know, like how some people have big noses. You have a big thyroid." Ummm, what? How does that make any sense? I never had an enlarged thyroid, and now all of a sudden I do...obviously there is an issue there. But I digress...so all of this occurred a year and a half ago. During this year and a half I have been getting migraines, anxiety attacks, depressed, no energy at all (I go to bed at 10:30pm and wake at 7:00am), brain fog, feeling 'out of it', always run down, irritable, constipated etc. I can be here all day naming my symptoms. I went to multiple doctors and had multiple tests done. All coming back 'normal. Now, over the past few months my symptoms have been getting worse and now I am having difficulty breathing/swallowing. So, my question is....is it possible to have hypothyroidism with normal lab results? Any one else experience this? It is impossible to get an appointment with an endocrinologist where I live, my appointment is April 9th and this is the earliest they had! All other doctors were booking appointments in May :-(
Thank you for reading!
-Marisa
I hope you get some answers tomorrow. Best of luck with the endo. Let me know how it goes.
My mom does not have Hashi's...she does go every 6 months for a biopsy and blood work to monitor her thyroid though. Hopefully the endo I see tomorrow will be able to do a U/S right away. I really do not understand how they can give me a diagnosis but size be normal and then two separate doctors (one an endo another a primary) do a physical test and say I do in fact have a goiter. I just want answers to why I'm feeling as I do :-(
Thank you and 898_1 for all your help.
Thank you and 898_1 for all your help.
I have (or had) a bunch of nodules, too. They come with Hashi's. My thyroid is now dead, but not gone, so it's now smaller than average (atrophying). I got a glimpse of my last U/S, and it looked like the craters of the moon. Does your Mom have Hashi's?
I looks very much to me like the ENT didn't want to admit he was wrong. As 898_1 pointed out, and as I felt as well, the "diagnoses" on that report are completely contradicted by the findings of the U/S, which is completely normal. No nodule was found, and the dimensions clearly fall within normal limits:
"The thyroid gland is an H-shaped organ composed of two lobes joined by a narrow isthmus located just below the laryngeal cartilages. The normal thyroid weighs approximately 15 to 25 g, with each lobe 4 to 6 cm in length and 1.3 to 1.8 cm in thickness. The isthmus measures less than 4 to 5 mm."
However, a repeat U/S should clear this all up.
I looks very much to me like the ENT didn't want to admit he was wrong. As 898_1 pointed out, and as I felt as well, the "diagnoses" on that report are completely contradicted by the findings of the U/S, which is completely normal. No nodule was found, and the dimensions clearly fall within normal limits:
"The thyroid gland is an H-shaped organ composed of two lobes joined by a narrow isthmus located just below the laryngeal cartilages. The normal thyroid weighs approximately 15 to 25 g, with each lobe 4 to 6 cm in length and 1.3 to 1.8 cm in thickness. The isthmus measures less than 4 to 5 mm."
However, a repeat U/S should clear this all up.
Sorry about that....my GRANDmother had a goiter and they removed it. My MOTHER has several nodules and a benign tumor on her thyroid.
The ENT discovered the goiter and ordered the U/S....a tech conducted the actual scan and the ENT reviewed and wrote the report. The ENT then told me to see an endocrinologist for the goiter.
The ENT discovered the goiter and ordered the U/S....a tech conducted the actual scan and the ENT reviewed and wrote the report. The ENT then told me to see an endocrinologist for the goiter.
What was your mother's surgery for? Did she have thyroid cancer or Graves'?
So, the ENT who interpreted your U/S report wasn't the doctor who referred you for the U/S?
So, the ENT who interpreted your U/S report wasn't the doctor who referred you for the U/S?
This is what has confused me as well. Unfortunately on top of all of these 'questionable' findings, I had doctors that were of very little help. This U/S was done by an ENT and when given the report she stated to me...oh no your thyroid is just enlarged, go see an endo. So I made an appointment with an endo, he gave me a physical exam of my throat. Stated "you know how some people have big noses? Well, you have a enlarged thyroid". Didn't ask for a copy of my scan nor did he follow up with much else. Then he retired a month later. It is my own fault for not following up but since everyone dismissed this I figured it wasn't a big deal.
I just recently learned my mother had a similar experience as me when she was in her 30s. Many of the same symptoms, dismissals of doctors and ultimately/FINALLY her labs showed abnormal thyroid levels so she had to go for surgery on her thyroid.
I'm just tired of the constant guessing game. I was able to call in a favor of a friend and have an appointment with a new endo tomorrow morning.
I just recently learned my mother had a similar experience as me when she was in her 30s. Many of the same symptoms, dismissals of doctors and ultimately/FINALLY her labs showed abnormal thyroid levels so she had to go for surgery on her thyroid.
I'm just tired of the constant guessing game. I was able to call in a favor of a friend and have an appointment with a new endo tomorrow morning.
I sent your U/S report to another of our members, 898_1, who knows imaging much better than I. He posted above quite a while ago.
I contacted him because I was confused. How can you have a diagnosis of "nontoxic uninodular goiter" and go on to say that everything is "normal in size"? How can you have one nodule with no nodule described? That's a contradiction in terms.
So, here's 898_1's comment:
"This report shows no abnormalities. Period. (Its size is about 7ml )
What probably happened,her doctor suspected nodule during palpation.
so he or she wrote the request for ultrasound due to POSSIBLE goiter (nodule).
In addidtion, some people are having prominent voice box/peritracheal fascia that make them look like they are having goiter.
The false negative or positive rate for manual thyroid exam (palpation) is 30%. nodules less than 1cm are not normally detected by palpation; only ultrasound or MRI can reliably detect them
the voice box undergoes calcification and bone transformation process (with age) it causes it to be larger on the outside (more than 80 years ago mostly men had this, but now variable data shows that many women are having this as well) It normally starts after 40 years of age, but can start even in late teens; in most cases the voice does not change."
So, it seems that you never did have a goiter; that was just the possible diagnosis provided by your doctor when he referred you for U/S. The U/S did not corroborate his findings. As 898_1 pointed out, palpation has a very high false positive and false negative rate. U/S is much more accurate.
So, while I think it's still a good idea to follow up with another U/S, if for no other reason than your peace of mind, I suspect that the U/S will not give you the answer to your breathing/swallowing difficulties.
I contacted him because I was confused. How can you have a diagnosis of "nontoxic uninodular goiter" and go on to say that everything is "normal in size"? How can you have one nodule with no nodule described? That's a contradiction in terms.
So, here's 898_1's comment:
"This report shows no abnormalities. Period. (Its size is about 7ml )
What probably happened,her doctor suspected nodule during palpation.
so he or she wrote the request for ultrasound due to POSSIBLE goiter (nodule).
In addidtion, some people are having prominent voice box/peritracheal fascia that make them look like they are having goiter.
The false negative or positive rate for manual thyroid exam (palpation) is 30%. nodules less than 1cm are not normally detected by palpation; only ultrasound or MRI can reliably detect them
the voice box undergoes calcification and bone transformation process (with age) it causes it to be larger on the outside (more than 80 years ago mostly men had this, but now variable data shows that many women are having this as well) It normally starts after 40 years of age, but can start even in late teens; in most cases the voice does not change."
So, it seems that you never did have a goiter; that was just the possible diagnosis provided by your doctor when he referred you for U/S. The U/S did not corroborate his findings. As 898_1 pointed out, palpation has a very high false positive and false negative rate. U/S is much more accurate.
So, while I think it's still a good idea to follow up with another U/S, if for no other reason than your peace of mind, I suspect that the U/S will not give you the answer to your breathing/swallowing difficulties.
Since we are semi on topic, I also like to point out that I do not consume any dairy products and try to stay away from gluten. Dairy tends to bloat me so by choice I stay away (not lactose intolerant), I can consume without any issues just works as an inflammatory for me. I also avoid soy, as directed previously by my nutritionist.
Oh! My apologies....I thought you were asking if I currently take any supplements, which I do not. However, at the time of my blood work I was taking Inositol (a form of vitamin B) as directed by my nutritionist. So that was most likely a contributing factor to why my Vit B was so high.
Okay well this is a quote from Chris Kresser's article: What Everyone (Especially Vegetarians) Should Know About B12 Deficiency...
"Also, be aware that a high serum B12 does not necessarily rule out functional/active B12 deficiency. In fact, I have come to view a high serum B12 in the absence of supplementation as a potential red flag for active B12 deficiency."
"Also, be aware that a high serum B12 does not necessarily rule out functional/active B12 deficiency. In fact, I have come to view a high serum B12 in the absence of supplementation as a potential red flag for active B12 deficiency."
Not at all! As you said, the default for new members say male! Plus I didn't have a pic :-) haha
I have been researching Iron/Ferritin and saw the healthy ranges. What boggles my mind is that why do labs say 'normal' ranges are between 10 - 154 for ferritin! Now this is all starting to make so much sense, forgive me if I'm being too graphic or personal here but I notice all of my symptoms are exacerbated a few days before, during and a few days after mensuration. While all other times of the month I'm able to push myself, but during that time I am practically paralyzed.
Yes, that is the entire U/S report. I will be calling my doctor tomorrow to schedule another U/S.
I have been researching Iron/Ferritin and saw the healthy ranges. What boggles my mind is that why do labs say 'normal' ranges are between 10 - 154 for ferritin! Now this is all starting to make so much sense, forgive me if I'm being too graphic or personal here but I notice all of my symptoms are exacerbated a few days before, during and a few days after mensuration. While all other times of the month I'm able to push myself, but during that time I am practically paralyzed.
Yes, that is the entire U/S report. I will be calling my doctor tomorrow to schedule another U/S.
Oh, see now, you've posted a picture, and everyone who reads this thread is going to think I'm out of my mind! LOL I can just hear it now...she had to ASK if she was male or female!
Okay, so, I believe if you research iron, you will find that 70 is the extreme lower end of the range for menstruating women. Your iron level is much lower than it appears using your lab range that includes the entire population (including men and post-menopausal women). Ferritin is the protein that stores iron and releases it in a controlled fashion. So, low ferritin levels indicate iron deficiency anemia.
I hope I'm helping. It's a tough world out there to navigate in.
That's the entire U/S report, correct?
Okay, so, I believe if you research iron, you will find that 70 is the extreme lower end of the range for menstruating women. Your iron level is much lower than it appears using your lab range that includes the entire population (including men and post-menopausal women). Ferritin is the protein that stores iron and releases it in a controlled fashion. So, low ferritin levels indicate iron deficiency anemia.
I hope I'm helping. It's a tough world out there to navigate in.
That's the entire U/S report, correct?
I really truly appreciate how invested and helpful you are in my issue....you don't often come across people as nice as you. I cannot thank you enough.
I guess I can't get my act together today. I usually manage to get everything down in one post. I also meant to tell you that I'm picking someone's brain on your U/S report because I find it confusing, too.
I'm asking whether you are male or female because it changes the discussion on iron.
I know you said you were 28. Are you really male as your profile page says? (Male is the default, and sometimes people don't notice to change it.)
Is that the entire U/S report?
Is that the entire U/S report?
What I do not understand is on the same lab report it states Iron, total is at 70 with a range of 40-175. But my ferritin is so low. I do have a copy of my US it states:
Diagnoses: nontoxic uninodular goiter
Scan states: right thyroid normal in size and measures 3.8 x 1.4 x 1.3cm
left thyroid normal in size and measures 3.8 x 1.3 x 1.4cm
Isthmus normal in size and measures 3.0 mm in maximal AP diameter.
This scan was done August 2012 and done by an ENT.
This was also before I had an issues with the size of the goiter, I actually went to the ENT for a sinus infection and they found the goiter.
What I am thinking is that I am experiencing hypo symptoms but my thyroid is working double over time in order to function properly (just like how you suggested). My mother and I have been saying this for a few months now, my body is giving me warnings but my labs aren't showing abnormalities as of yet. And unfortunately, many doctors don't treat you until u get out of that 'normal' range as per the lab. Which is so ridiculous!
Diagnoses: nontoxic uninodular goiter
Scan states: right thyroid normal in size and measures 3.8 x 1.4 x 1.3cm
left thyroid normal in size and measures 3.8 x 1.3 x 1.4cm
Isthmus normal in size and measures 3.0 mm in maximal AP diameter.
This scan was done August 2012 and done by an ENT.
This was also before I had an issues with the size of the goiter, I actually went to the ENT for a sinus infection and they found the goiter.
What I am thinking is that I am experiencing hypo symptoms but my thyroid is working double over time in order to function properly (just like how you suggested). My mother and I have been saying this for a few months now, my body is giving me warnings but my labs aren't showing abnormalities as of yet. And unfortunately, many doctors don't treat you until u get out of that 'normal' range as per the lab. Which is so ridiculous!
Here's what we have so far:
1-FT3 and FT4 a little on the low side, but not terribly.
2-TPOab and TGab negative.
3-Vitamin D and ferritin deficiency.
4-Lots of hypo symptoms.
5-Goiter causing breathing/swallowing issues.
FT3 and FT4 measure the serum levels of the two hormones. However, one more step has to happen...thyroid hormones have to be able to get into cells, where they can be used. There is currently no way to measure tissue thyroid hormone levels. So, we extrapolate what we can. We know that D and ferritin have to be in cells in sufficient quantity for thyroid hormones to get into the nucleus of the cell. If D and ferritin are too low, the thyroid hormone can't be used by cells, and the result is that you feel hypo even though your serum levels are adequate.
In addition, both D and ferritin are necessary for the synthesis of thyroid hormones in the thyroid.
So, correcting the deficiencies could resolve a lot of your symptoms by allowing that thyroid hormone to get into your cells. In addition, higher D and ferritin presence in the thyroid could nudge those "little bit" low FT3 and FT4 levels up a notch, right into "optimal" range. I think you should work with your doctor to aggressively treat the deficiencies.
So that brings us to #5. A goiter is just an enlargement of the thyroid. It can be cause by antibodies causing inflammation, or it can be the result of the thyroid "working too hard". Think of it like a muscle...you work it hard, it gets bigger. One of the things that can cause it to work too hard is lack of the building blocks that make thyroid hormone. The classic example of this is a lack of iodine, which can cause the thyroid to get huge. Can lack of D and ferritin do the same? I'm sure they can contribute, although to a much lesser extent than iodine.
So, while I'm fairly confident that increasing those levels could help your hypo symptoms, I'm not sure the effect it will have on your goiter.
After another U/S, you'll be able to see what's changed and use that as a baseline to see what correcting the deficiencies does.
Do you have a copy of the first U/S report?
1-FT3 and FT4 a little on the low side, but not terribly.
2-TPOab and TGab negative.
3-Vitamin D and ferritin deficiency.
4-Lots of hypo symptoms.
5-Goiter causing breathing/swallowing issues.
FT3 and FT4 measure the serum levels of the two hormones. However, one more step has to happen...thyroid hormones have to be able to get into cells, where they can be used. There is currently no way to measure tissue thyroid hormone levels. So, we extrapolate what we can. We know that D and ferritin have to be in cells in sufficient quantity for thyroid hormones to get into the nucleus of the cell. If D and ferritin are too low, the thyroid hormone can't be used by cells, and the result is that you feel hypo even though your serum levels are adequate.
In addition, both D and ferritin are necessary for the synthesis of thyroid hormones in the thyroid.
So, correcting the deficiencies could resolve a lot of your symptoms by allowing that thyroid hormone to get into your cells. In addition, higher D and ferritin presence in the thyroid could nudge those "little bit" low FT3 and FT4 levels up a notch, right into "optimal" range. I think you should work with your doctor to aggressively treat the deficiencies.
So that brings us to #5. A goiter is just an enlargement of the thyroid. It can be cause by antibodies causing inflammation, or it can be the result of the thyroid "working too hard". Think of it like a muscle...you work it hard, it gets bigger. One of the things that can cause it to work too hard is lack of the building blocks that make thyroid hormone. The classic example of this is a lack of iodine, which can cause the thyroid to get huge. Can lack of D and ferritin do the same? I'm sure they can contribute, although to a much lesser extent than iodine.
So, while I'm fairly confident that increasing those levels could help your hypo symptoms, I'm not sure the effect it will have on your goiter.
After another U/S, you'll be able to see what's changed and use that as a baseline to see what correcting the deficiencies does.
Do you have a copy of the first U/S report?
Since my vitamin D levels and Ferritin levels are extremely low for thyroid function, what are they indicating?
Most definitely with the U/S. And I really cannot thank you enough for all of your help! I will post any updates and schedule the ultrasound. And do the other labs. You are truly an angel! I have been going through an extensive about of debilitating symptoms for almost 2 years now. I've lost friends over it, my marriage is struggling because of it and I almost lost my job. I am getting worse each day. I'm only 28 years old and when I'm not at work I am home sleeping or trying not to let my symptoms get the best of me. I really cannot thank you enough for taking the time to look over my labs and provide so much information! You are heaven sent!
I just had to educate myself on all things thyroid to get proper treatment for my thyroid condition. I have absolutely no professional education. I found an interest/obsession. LOL This, I believe, is a really good forum. There are a lot of us who do and share a lot of research (and some theorizing). I got a lot of help here.
I think an U/S is next. Compare current results with prior results and see what's changed.
I think an U/S is next. Compare current results with prior results and see what's changed.
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Please post any results you have with reference ranges. Ranges vary lab to lab, so you have to take them from your own lab report.
Did you ever have thyroid antibody tests?